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Fernandez-Egea E, Chen S, Sangüesa E, Gassó P, Biria M, Plaistow J, Jarratt-Barnham I, Segarra N, Mas S, Ribate MP, García CB, Fineberg NA, Worbe Y, Cardinal RN, Robbins TW. The role of psychosis and clozapine load in excessive checking in treatment-resistant schizophrenia: longitudinal observational study. Br J Psychiatry 2024; 224:164-169. [PMID: 38652060 PMCID: PMC11039551 DOI: 10.1192/bjp.2024.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 01/22/2024] [Accepted: 02/05/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND A significant proportion of people with clozapine-treated schizophrenia develop 'checking' compulsions, a phenomenon yet to be understood. AIMS To use habit formation models developed in cognitive neuroscience to investigate the dynamic interplay between psychosis, clozapine dose and obsessive-compulsive symptoms (OCS). METHOD Using the anonymised electronic records of a cohort of clozapine-treated patients, including longitudinal assessments of OCS and psychosis, we performed longitudinal multi-level mediation and multi-level moderation analyses to explore associations of psychosis with obsessiveness and excessive checking. Classic bivariate correlation tests were used to assess clozapine load and checking compulsions. The influence of specific genetic variants was tested in a subsample. RESULTS A total of 196 clozapine-treated individuals and 459 face-to-face assessments were included. We found significant OCS to be common (37.9%), with checking being the most prevalent symptom. In mediation models, psychosis severity mediated checking behaviour indirectly by inducing obsessions (r = 0.07, 95% CI 0.04-0.09; P < 0.001). No direct effect of psychosis on checking was identified (r = -0.28, 95% CI -0.09 to 0.03; P = 0.340). After psychosis remission (n = 65), checking compulsions correlated with both clozapine plasma levels (r = 0.35; P = 0.004) and dose (r = 0.38; P = 0.002). None of the glutamatergic and serotonergic genetic variants were found to moderate the effect of psychosis on obsession and compulsion (SLC6A4, SLC1A1 and HTR2C) survived the multiple comparisons correction. CONCLUSIONS We elucidated different phases of the complex interplay of psychosis and compulsions, which may inform clinicians' therapeutic decisions.
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Affiliation(s)
- Emilio Fernandez-Egea
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK; Department of Psychiatry, University of Cambridge, UK; and Behavioural and Clinical Neuroscience Institute, University of Cambridge, UK
| | - Shanquan Chen
- Department of Psychiatry and Division of Psychology and Language Sciences, University College London, UK
| | | | - Patricia Gassó
- Department of Basic Clinical Practice, University of Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; and Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Marjan Biria
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, UK; and Department of Psychology, University of Cambridge, UK
| | - James Plaistow
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Isaac Jarratt-Barnham
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK; Medical Sciences Division, University of Oxford, UK
| | - Nuria Segarra
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Sergi Mas
- Department of Basic Clinical Practice, University of Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; and Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | | | | | - Naomi A. Fineberg
- Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, UK; and School of Life and Medical Sciences, University of Hertfordshire, UK
| | - Yulia Worbe
- Department of Neurophysiology, Sorbonne Université, France; Department of Neurophysiology, Saint-Antoine Hospital, Paris, France; and Institute du Cerveau et de la Moelle Epinière, Paris, France
| | - Rudolf N. Cardinal
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK; and Department of Psychiatry, University of Cambridge, UK
| | - Trevor W. Robbins
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, UK; and Department of Psychology, University of Cambridge, UK
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Almeida-Calpe A, López de Frutos L, Medrano-Engay B, García-García CB, Ribate MP, Giraldo P. Metabolizing profile of the cytochrome pathway CYP2D6, CYP3A4 and the ABCB 1 transporter in Spanish patients affected by Gaucher disease. Chem Biol Interact 2021; 345:109527. [PMID: 34058179 DOI: 10.1016/j.cbi.2021.109527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/15/2021] [Accepted: 05/16/2021] [Indexed: 10/21/2022]
Abstract
Several therapeutic options are available for type 1 Gaucher disease (GD1), including enzymatic replacement therapy (ERT) and substrate reduction therapy (SRT). Eliglustat is a selective inhibitor of glucosylceramide synthase that is extensively metabolized by CYP2D6 and, to a lesser extent by CYP3A4; it is also an inhibitor of the P-gp transporter. The aim of this study is to evaluate the metabolizer profile of these cytochrome isoforms in 61 GD1 patients, and to analyze interferences with concomitant therapies. Patients were selected from the Spanish Gaucher Disease Registry considering clinical data, GBA genotype, severity score index, comorbidities, concomitant drugs, type and response to therapy and adverse effects. The polymorphisms of CYP2D6, CYP3A4 and three ABCB1 transporter variants were analyzed by Polymerase Chain Reaction (PCR). The most frequent metabolizer profile was extensive or intermediate for CYP2D6, extensive for CYP3A4*1B and CYP3A4*22 and normal activity for ABCB1. Correlations between metabolizer profile and other variables were analyzed by multiple regression study. Twenty-eight patients received ERT, 17 eliglustat and seven miglustat. Forty-two patients (68.8%) had associated diseases and 54.5% were taking daily concomitant medication. Nine patients under eliglustat therapy received concomitant drugs that interact with the CYPs and/or ABCB1, five of these did not reach therapeutic goals and three presented mild or moderate adverse effects (headache and gastrointestinal disorders). Detailed analysis in four patients with TTT haplotype, corresponding to lack of activity of the transporter, was performed. In order to apply personalized medicine and avoid interferences and adverse effects, the individual CYP metabolizer profile and transporter must be considered when choosing the concomitant medication and/or making dose adjustments.
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Affiliation(s)
- A Almeida-Calpe
- Facultad de Ciencias de la Salud. Universidad San Jorge, Zaragoza, Spain
| | - L López de Frutos
- Fundación Española para el Estudio y Terapéutica de la Enfermedad de Gaucher y otras lisosomales (FEETEG), Zaragoza, Spain; Grupo de Investigación en Enfermedades Metabólicas y Hematológicas Raras (GIIS-012), Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain; Grupo Español de Enfermedades de Depósito Lisosomal, Sociedad Española de Hematología y Hemoterapia, Zaragoza, Spain
| | - B Medrano-Engay
- Fundación Española para el Estudio y Terapéutica de la Enfermedad de Gaucher y otras lisosomales (FEETEG), Zaragoza, Spain
| | - C B García-García
- Facultad de Ciencias de la Salud. Universidad San Jorge, Zaragoza, Spain
| | - M P Ribate
- Facultad de Ciencias de la Salud. Universidad San Jorge, Zaragoza, Spain
| | - P Giraldo
- Fundación Española para el Estudio y Terapéutica de la Enfermedad de Gaucher y otras lisosomales (FEETEG), Zaragoza, Spain; Grupo de Investigación en Enfermedades Metabólicas y Hematológicas Raras (GIIS-012), Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain; Grupo Español de Enfermedades de Depósito Lisosomal, Sociedad Española de Hematología y Hemoterapia, Zaragoza, Spain.
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Mínguez M, Ibáñez B, Ribate MP, Ramos F, García-Alegría E, Fernández-Rivas A, Ruiz-Parra E, Poch M, Alonso A, Martinez-Bouzas C, Beristain E, Tejada MI. Risk of cognitive impairment in female premutation carriers of fragile X premutation: analysis by means of robust segmented linear regression models. Am J Med Genet B Neuropsychiatr Genet 2009; 150B:262-70. [PMID: 18563710 DOI: 10.1002/ajmg.b.30803] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This report describes a study focused on the relationship between CGG repeat length, FMRP, mRNA levels and cognitive functioning in premutation carriers (PM) carriers of Fragile X Syndrome (FXS). We studied 60 females-43 with PM and 17 with normal (N) alleles-from 25 FXS Spanish families. The Wechsler scales were administered to all subjects and new blood samples and hair roots were taken to study mRNA and FMRP levels. Using lowess curves together with segmented models we showed that within the premutation range, IQ scores tend to decrease when the number of CGG repeats increases and the FMRP values decrease. Furthermore, we discovered cut-off points in the molecular variables that seem to change the probability of having some cognitive impairment. Specifically, for those PM females in the upper premutation range (CGG > or = 100) and with FMRP expression < 60% in hair roots, a 10% decrement of FMRP expression represents a significant decrease in IQ scores of about six points, which is more evident for Full-Scale IQ (P-value = 0.035) and Performance IQ (P-value = 0.045) than for Verbal IQ (P-value = 0.074). On the contrary, we did not find any significant correlation between FMR1 mRNA levels and the IQ scores, probably due to the fact that mRNA levels were measured in blood. In conclusion, our findings suggest that the PM can have some effect on cognitive ability in female carriers, although these effects may be subtle. In these cases, it would be advisable to carry out a hair root analysis of FMRP.
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